Wound Healing: Impaired Healing – Inflammation and Wound Repair

A wound is the loss of the normal integrity of the skin and underlying soft tissue leading to a devitalized structure. Wounds can result from a skin injury, such as in the case of surgery, puncture wounds and abrasions or can be secondary to skin necrosis as a result of ischemia or pressure. People with diabetes mellitus, peripheral ischemia, venous stasis, infection and bad nutritional status are vulnerable to wounds due easy skin disruption and difficult healing processes that may lead to chronic ulcers. The process of wound healing occurs to protect the underlying structures from infection or blood loss. Wound healing occurs through several physiological stages in healthy individuals that include hemostasis, inflammation, epithelialization (granulation) or proliferation and finally fibroplasia or remodeling.

00:01
What may then cause impaired healing? Infections, diabetes
mellitus for sure. Not only will there be peripheral vasculardisease but then also neuropathy. Poor nutrition may result
in decreased protein which is very much required for wound healing.
00:22
Vitamin C deficiency. The picture is showing you why you need
proper vitamin C so that you can hydroxylate yourcollagen. The cross-linking has now been decreased in vitamin C
deficiency. Welcome to scurvy. Look for major haemarthrosis.
00:39
Gum bleeding, scurvy. Look for malnutrition. Zinc is required
for collagenase. Copper is required for oxidase.
00:49
In biochemistry make sure that you keep your oxidase separate
from hydroxylase. Hydroxylase, vitamin C. Oxidase, copper.
01:01
Collagenase, zinc. In fact, if you go to the local pharmacy,
you can always find zinc complements or zinc supplementsin which they claim that it helps with immunity. It does,
we need it endogeneously. But beyond that.
01:19
Anyhow, people use different things for marketing. Know as to why.
There is some truth to the fact that zinc is required for collagenase.
01:28
Glucocorticoids. Why would a patient require glucocorticoids. If
it's causing decreased wound healing, pause here for one second.
01:40
Glucocorticoid, very interesting drug is'nt it. Glucocorticoid
causes neutrophilic leucocytosis. Glucocorticoid causeslymphopenia. Glucocorticoid causes decreased wound healing. Think
of a patient. You are a plastic surgeon. You want to be aplastic surgeon? Go do it. Don't let anyone stop you from
being what you want to be. You have a thriving plastic surgerypractice. You are doing face lifts. When you do a face lift
you are introducing wound into your patient on the face.
02:13
Do you want much scar formation and collagen deposition? Of
course not. So you purposely are then going to injectglucocorticoid derivatives into the patient so that you can
then monitor and supervise the amount of wound or excuse me.
02:30
The healing that is taking place in your patient. Obviously
you are not going to put so much where it does'nt heal at all.
02:36
But what you are doing is minimizing scar formation. So when the
bandages come of the face, your patient looks"Oh I am so beautiful Doc". Thanks to you. And your practice begins
to thrive, or has been. Anyhow, interesting huh, glucocorticoids.
02:54
Organ repair. Liver, potential for regenerative nodules. That's
important. Meaning to say that during the repair processyou might actually have nodules taking place. Lung, type
II pneumocytes will help you repair Clara cells.
03:08
Help you repair. In the brain, it's called gliosis. Notice
here there are no fibroblast. Yes, in the brainthere are no fibroblast. But Dr. Raj why would you call this a
gliotic scar? It's a misnomer. You have gliosis which will beastrocytes and microglial cells. They will come in and
repair the brain. Your liquefacting necrosis as you knowbut you end up forming a cavity. Peripheral nerve, something called
Wallerian degeneration where Schwann cells will play a key role.

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